Impacts of pregnancy among quilombola adolescents

Abstract Objective: understand the impacts of pregnancy on the lives of quilombola adolescents. Method: this is a qualitative study using an exploratory descriptive design. Ten quilombola mothers who experienced pregnancy during adolescence participated in this study. Data were collected through semi-structured interviews and then submitted to content analysis. Results: three categories were identified, showing the knowledge of the participants about being a quilombola and about the impacts on their lives after discovering they were pregnant and how they handled the fact of being a mother-adolescent according to the adaptations and expectations of their new phase. Conclusion: pregnancy in adolescence had impacts on several aspects of the lives of adolescents, with psychological, educational, socioeconomic, and family implications, as well as new responsibilities. Also, this study highlights the role of pregnant adolescent reception of nursing professionals to meet the individual needs of adolescents and develop prevention strategies to help reduce pregnancy among quilombola adolescents.


Introduction
Adolescent pregnancy has become a serious public health problem (1) . Data from the Ministry of Health (MS) in Brazil show that more than 20,000 girls under the age of 15 years become pregnant every year (2) . In addition, several factors lead to adolescent pregnancy, including: socioeconomic aspects, low educational level, reduced age both at menarche and at first sexual intercourse, lack of information about contraceptives or programs that support adolescents (3) . Early pregnancy affects the personal-social context, causing biological, psychological, economic, and family changes, school abandonment, and financial dependence on parents (4) .
Although pregnancy rates have dropped in recent years in Brazil (5)(6) , the adolescent pregnancy rate is high, with 400,000 cases every year. Regarding the age group, data show 28,244 children were born to mothers aged 10 to 14 years and 534,364 children to mothers aged between 15 and 19 years in 2014 (6) , with higher prevalence among black women, with low educational and socioeconomic levels, in the North and Northeast regions (7)(8) of the country. Considering these data, social inequality and discrimination make Brazilian adolescents victims of exclusion and misery, showing a growing trend of events that increase impoverishment and consequent social vulnerability, exposing black women, from an early age, to situations that put them at physical, psychological, and social risk (9) .
De s p i t e t h e n a t i o n al p o l i c y fo c u s e d o n adolescence (10) , it does not consider the specificities of different adolescences, based on aspects of ethnicity, history, and transculturality. In this context, quilombola communities, comprised of Afro-descendants according to self-attribution criteria and which present cultural singularities, are victims of social vulnerability, with an impact on their health conditions, especially those located in rural areas (11) . Then, nursing care is key when planning strategies for the prevention and monitoring of adolescent pregnancy, since nurses are inserted in the context of these communities and they know the real needs and vulnerabilities of this population. These strategies must include sexual and reproductive health, youth protagonism, life project, in addition to family involvement, and multidisciplinary actions.
The influence of health inequality inherent to the context of black quilombola adolescents is also highlighted, justifying the need to investigate this theme. Also, in a search to analyze the status of this theme in the Scientific Electronic Library Online (SciELO) and the Virtual Health Library (BVS) databases, using descriptors quilombola, adolescents, and nursing, with Boolean AND, no study was found addressing nursing care regarding the impact of pregnancy on quilombola adolescents.
Given the above, this study aimed to understand the impact of pregnancy on the lives of quilombola adolescents. Its results may support planning of nursing care focused on quilombola adolescents who experience early pregnancy.

Study design
This is a field study, with an exploratory descriptive qualitative approach (12) , based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) (13) .

Study site, period, and participants
This study was conducted in the quilombola community of São Francisco do Paraguaçu, located in the municipality of Cachoeira, Bahia, Brazil, between October 25 and 30, 2021. Ten mothers from this community who experienced pregnancy during adolescence participated in the study. This group was selected due to the scarcity of studies addressing this theme in the quilombola population.
The following inclusion criteria were adopted for participant selection: quilombola mothers who have experienced pregnancy during adolescence, considering a maximum period of three years for short-, medium-, and long-term impacts of pregnancy. The exclusion criteria were: deaf mothers, due to the researcher's limitation while adjusting the collection technique; and mothers of children with special needs, considering this condition implies changes in the daily routine of maternal care.
No participant was excluded.
The participants were contacted after requesting the coordination of the local quilombola association, which allowed the selection of mothers for the study and individual contact at their homes.
Although qualitative studies do not previously restrict the number of participants, and data collection takes place until the study topic is fully understood, it was initially defined that ten mothers would be interviewed, and it was coincidently the number of interviews performed to obtain saturation of empirical data. No participant refused to participate or withdrew from the study.

Instruments and data collection
Semi-structured interview was used as a data collection technique (14) . The instrument had two www.eerp.usp.br/rlae The eligible women signed an informed consent form. Neither an assent form nor authorization from guardian was required because all mothers were over 18 years old. Then, the data collection procedure was explained, and the women were asked for permission to record their testimonies.

Data processing and analysis
The content analysis proposed by Minayo (15)

Ethical aspects
This study observed the ethics criteria of Resolutions nº 466/2012 (16) and 510/2016 (17) for research with human beings and was approved by the research ethics committee, approval nº 5.053.597.

Results
Ten mothers participated in the study, aged 18 to 22 years. Regarding education, only two had a higher education degree, one had high school degree, and seven had not concluded elementary school.
In terms of occupation, most participants (eight) performed activities in common, such as fishing, cleaning shellfish, cleaning houses, and selling clothes, while two of them only studied. Race/color was defined by selfclassification: eight self-declared black and two self- Based on the analysis of the interviews, the following categories were defined: quilombola identity in the perspective of women, impacts of pregnancy in adolescence, and discovery of maternal identity.

Impacts of pregnancy in adolescence
In this category, we will discuss the implications in the lives of these adolescents after the discovery of pregnancy, mainly related to the psychological, educational, socioeconomic, family, and social aspects.
Regarding the psychological aspects of the experience of becoming pregnant in adolescence, the participants mentioned several feelings, in addition to the desire for motherhood.

Discovery of maternal identity
In this category, the participants explained how it felt to be a mother as an adolescent, especially in relation to adaptations and expectations in the new phase:

Discussion
In quilombola communities, residents report feelings of ethnicity, identity empowerment, and belonging to the territory (18) , which are then interpreted as material and symbolic survival of the quilombola identity and its continuous reaffirmation (18) . Then, when talking about being a quilombola, the participants recalled the process of resistance to the different forms of oppression that black people, quilombo remnants, faced in the past when fighting for dignified living conditions. In agreement with the participants, many studies report quilombos were the most significant manifestation of captive resistance ever seen in Brazil and became synonymous with fight for rights (19) .
The participants also pointed out the racial and appreciation of their culture; fight against racism and racial discrimination, among others (21) . beyond what is offered to them by governmental and/or local policy. Then, we emphasize the need for health professionals to reformulate their practices aiming to redefine the image of adolescents and promote alternative and creative practices that value youth protagonism (23) .
Regarding future projects, there is no evidence of medium-and long-term planning of participants, not to mention old plans abandoned prior to pregnancy.
When comparing our findings to those of a study with pregnant adolescents (24) , the results were similar only with girls who had been submitted to violence, so we can associate the historical context of quilombo with the absence of life projects.
When thinking about the rights attributed to the remaining quilombolas, it is important to formulate public policies that can promote social equity and equal rights to this segment, since there is still an immeasurable debt inherited from the historical and social process that involves the creation of the country, whose influences have influenced its existential conditions (21) . Pregnancy among quilombola adolescents causes several changes in the lives of boys and girls and is related to major emotional, educational, social, and economic consequences (26) . Unplanned or unwanted pregnancy can generate different feelings in a pregnant woman (27) , such as insecurity, fear, shame, as well as loss of autonomy and higher risks of depression and suicide. Then, nurses, when providing prenatal care, must pay attention to the feelings of the adolescents during pregnancy, and refer them to specialized services of mental health care.
On the other hand, pregnancy may be desired by young women as a way to access a new status of identity and recognition through the maternal role (28) . Motherhood, in these cases, can be seen as an occupation, a role that gives a meaning to their lives. In the absence of other life projects or in case of challenges to establish alternative plans, pregnancy can be perceived by the adolescent as recognition or a path to finding her own space in the family or surrounding environments (28) .
Due to various social, political, and cultural elements, most black and poor adolescents living in Brazilian outskirts are generally unable to build their school and professional trajectory and enter the job market to ensure financial independence (29) . Then, they also end up finding a perspective of autonomy in pregnancy.
The challenges faced by these women -as pregnant adolescents -to continue their school routine, whether for financial reasons, lack of family support, or emotional conditions, show that school dropout is a critical finding to help understand that maternity in adolescence directly affects the construction of life projects. In addition, pregnancy in this age group directly impacts the perpetuation of the cycle of poverty and misery (30)  with other sectors and professionals to help reduce school dropout (31) .
Although adolescent pregnancy is a greater obstacle for black poor young women, it constitutes a factor that changes the socioeconomic conditions of mothers, who see in higher education training a possible element of socioeconomic transformation (32) , a condition that is not present only among quilombola women.
The participants clearly show a concern regarding the financial condition of their parents as they had to deal with a new member in the family, associated with the instability of the family's subsistence. For this reason, they need to work to contribute to the family income and fulfill their own needs and those of their child(ren). In this context, school dropout is a consequence of adolescent pregnancy (32) and ends up reducing the chances of these young women to find a formal job. This fact has an impact on the socioeconomic aspect, as most participants have informal jobs, such as fishing, shellfish cleaning, and house cleaning.
Besides the feelings resulting from the discovery of pregnancy, the participants had to deal with the opinion and acceptance of pregnancy by their parents, who initially expressed criticism, dissatisfaction, and concern about the future of their daughters.
In general, the participants reported that in the beginning of pregnancy, when they told their parents about it, they did not receive the expected support (33) . But, over time, the pregnancy was accepted by the family, and they had the necessary support (33) .
The mother figure was a "stronghold", allowing the adolescent to experience the pregnancy and birth process with tranquility (34) .
Regarding the child care being attributed to the mother, our findings show changes in the behavior of the adolescent father (11) . During pregnancy, he shares the care but, later, he assigns to mothers the responsibility for the child education and care at home, and the father becomes the family provider.
According to our study, pregnancy causes changes in the social cycle of the participants, so they assume new behaviors, showing responsibility and care due to the arrival of the child, as well as distress for having to be away from friends.
First pregnancy in adolescence has an impact on the adolescent's personal, family, social, and educational life.
In most cases, pregnancy changes her school life and makes her distant from social groups and life projects (35) .
With regard to friends, social support is extremely important for the acceptance of the pregnancy, because, when feeling supported, adolescents see pregnancy as a positive event. Then, strategies should be implemented to encourage stronger connections between the young woman and her family, partner, and friends so that she feels supported (34) .
Motherhood in adolescence causes constant and intense changes, as becoming a mother is a big challenge (36) , as mentioned by the participants. The reflections made about the concepts involved in becoming a mother in this period provided a better understanding of the changes in different aspects.
The statements of adolescents indicate motherhood was built as it was experienced, because, in fact, only one of the mothers showed the desire to become pregnant.
The others, because of an unexpected pregnancy, were not previously prepared for it.
The pregnancy discovery and experience of the participants involved new responsibilities in this new phase, when they were concerned about the wellbeing of the child and had fear regarding the newborn care. Adolescents, as they adapt to the new condition of being a mother, overcome the initial difficulties, develop and solidify the bond, love and complicity with the child, through the experience over the days, a fact that shows their relationship with the child. Therefore, the adolescent gradually builds her conception of mother, living in her own way and at her own pace to develop this child recognition, assuming her responsibilities, and starting to feel more confident about her maternal abilities (34) .

Conclusion
Adolescent pregnancy in a quilombola community triggered psychological and emotional implications; educational issues associated with the high school dropout rate, which, consequently, reduced professional opportunities; and socioeconomic problems, especially because the adolescents were already in a condition of vulnerability associated in the context of a quilombo.
Regarding family support, the participants reported rejection at first, but later they had support from their partner and family. Regarding the social aspect, distance from friends was reported as a result of the adaptations to the new phase.
The discovery of maternal identity involves feelings of motherhood acceptance, insecurities related to child care, as well as adaptation processes that are constituted as motherhood is experienced. In view of the above, it is important to strengthen health policies for this population aiming to disseminate information about preventive and educational measures, respecting, above all, the ethnic, historical, and sociocultural aspects. Then, the role of nursing is highlighted for the development of intersectoral prevention strategies that can effectively contribute to health promotion, with interventions that focus on youth protagonism, encouraging the development of life projects and safe sexuality, as well as care for pregnant adolescents in order to meet their individual needs, observing the particularities of being black and quilombola women.